Dicyclomine (20mg) + Paracetamol (500mg) + Mefenamic Acid (250mg) (Medical Monograph)

Overview

A fixed-dose combination (FDC) analgesic-antispasmodic medication primarily indicated for the symptomatic relief of moderate to severe pain associated with smooth muscle spasm, such as in dysmenorrhea, renal colic, and intestinal colic. Dicyclomine is an anticholinergic antispasmodic, Paracetamol is a centrally-acting analgesic and antipyretic, and Mefenamic Acid is a peripherally-acting NSAID with analgesic, anti-inflammatory, and antipyretic properties. This combination provides a multi-modal approach to pain relief by targeting both visceral spasm and pain pathways.

The combination exerts a synergistic effect. Dicyclomine acts as a competitive muscarinic acetylcholine receptor antagonist, reducing smooth muscle tone and motility in the gastrointestinal and genitourinary tracts. Paracetamol's exact mechanism is not fully elucidated but is believed to involve central inhibition of prostaglandin synthesis (COX-2 and COX-3 inhibition) and modulation of serotonergic and cannabinoid pathways. Mefenamic Acid is a reversible, competitive inhibitor of both cyclooxygenase (COX-1 and COX-2) enzymes, reducing the synthesis of prostaglandins, thromboxanes, and prostacyclins at the site of inflammation, thereby providing peripheral analgesic and anti-inflammatory effects.